Schulz Steffen, Fennema Peter, Darwich Ali, Bludau Frederic, Rickert Marcus
Orthopedic Trauma Surgery Center, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
AMR Advanced Medical Research, 8708 Männedorf, Switzerland.
J Clin Med. 2024 Nov 21;13(23):7012. doi: 10.3390/jcm13237012.
Cage implantation decompresses neural elements, stabilizes segments, and promotes fusion, with sagittal balance influenced by cage size, geometry, and position. This retrospective study compared the effects of lumbar interbody cages with 10° and 15° lordotic angles on global and segmental lordosis in patients undergoing transforaminal lumbar interbody fusion (TLIF). Data from 215 patients who underwent 259 TLIF procedures between 2018 and 2022 were analyzed. All the surgeries were performed by a single senior orthopedic spine surgeon, and cages were selected by the surgeon based on patients' clinical and anatomical factors. Radiographic assessments included measurements of global and segmental lordosis. Patients who received 15° cages demonstrated significantly greater segmental lordosis compared to those who received 10° cages in both bisegmental and monosegmental procedures ( < 0.001). While the global lordosis in the 10°-cage group remained unchanged postoperatively ( = 0.687), bisegmental procedures showed a small but statistically significant increase ( = 0.035). Moreover, global lordosis did not significantly differ between the 10°- and 15°-cage groups. Cage geometry significantly influenced segmental lordosis, with 15° cages achieving overall more superior radiographic results compared to 10° cages. However, global lordosis was unaffected by cage angle, thereby highlighting the multifaceted nature of factors that influence overall spinal alignment. These findings provide valuable insights into lumbar spine surgery, thus emphasizing the need for comprehensive preoperative planning and consideration of individual patient characteristics.
椎间融合器植入可使神经结构减压、稳定节段并促进融合，矢状面平衡受椎间融合器尺寸、几何形状和位置的影响。本回顾性研究比较了10°和15°前凸角的腰椎椎间融合器对接受经椎间孔腰椎椎间融合术（TLIF）患者的整体和节段性前凸的影响。分析了2018年至2022年间215例接受259例TLIF手术患者的数据。所有手术均由一位资深骨科脊柱外科医生进行，外科医生根据患者的临床和解剖因素选择椎间融合器。影像学评估包括测量整体和节段性前凸。在双节段和单节段手术中，接受15°椎间融合器的患者与接受10°椎间融合器的患者相比，节段性前凸明显更大（<0.001）。虽然10°椎间融合器组的整体前凸术后保持不变（=0.687），但双节段手术显示有小幅但具有统计学意义的增加（=0.035）。此外，10°和15°椎间融合器组之间的整体前凸无显著差异。椎间融合器的几何形状对节段性前凸有显著影响，与10°椎间融合器相比，15°椎间融合器在影像学上总体效果更佳。然而，整体前凸不受椎间融合器角度的影响，从而突出了影响脊柱整体排列的因素的多面性。这些发现为腰椎手术提供了有价值的见解，因此强调了全面术前规划和考虑个体患者特征的必要性。
